Thiazolidinediones ndi gulu latsopano la mankhwala apakamwa opatsirana. Monga biguanides, samachulukitsa kapamba, kumalimbikitsa kupangika kwa insulin, koma kumangochepetsa kukana kwa maselo mahomoni.
Kuphatikiza pa kukonzanso glycemia, mankhwalawa amakonzanso mawonekedwe a lipid: kuchuluka kwa HDL kumawonjezeka, kuchuluka kwa triglycerol kumachepa. Popeza mphamvu ya mankhwalawa imakhazikitsidwa ndi kusintha kwa majini, zotsatira zabwino zochizira zimatha kuyembekezeredwa m'miyezi iwiri kapena itatu. M'mayesero azachipatala, monotherapy yokhala ndi thiazolidatediones inachepetsa hemoglobin ya glycated kukhala 2%.
Mankhwala a gululi amaphatikizidwa bwino ndi othandizira ena odwala matenda ashuga - metformin, insulin, zotumphukira za sulfonylurea. Kuphatikizidwa ndi metformin ndikotheka chifukwa cha magwiridwe ena osiyana: biguanides inhibit glucogenesis, ndi thiazolidatediones imakulitsa kugwiritsidwa ntchito kwa glucose.
Samapangitsanso hypoglycemic zotsatira za monotherapy, koma, monga metformin, mu zovuta mankhwala okhala ndi hypoglycemic mankhwala amatha kuyambitsa zotere.
Monga mankhwala omwe amalimbikitsa chidwi cha zolandilira ku insulin, thiazolidatediones ali m'gulu la mankhwala olimbikitsa kwambiri pakuwongolera matenda a shuga a mtundu wachiwiri. Njira yodziteteza mukamaliza kumwa mankhwalawa imatha mpaka miyezi isanu ndi itatu kumapeto kwa maphunzirowo.
Pali lingaliro loti mankhwala a gululi amatha kukonza kuwonongeka kwa majini a metabolic, kuchedwa kupita patsogolo kwa matenda ashuga amtundu wa 2 mpaka kupambana kwathunthu pamatenda.
Mwa thiazolidinediones, mankhwala a 2 mbadwo Aktos wa kampani yopanga zamankhwala "Eli Lilly" (USA) adalembetsedwa pamsika waku Russia lero. Kugwiritsidwa ntchito kwake kumatsegula mwayi watsopano osati mu diabetesology, komanso mu mtima, komwe mankhwalawa amagwiritsidwa ntchito kupewa matenda a mtima ndi mitsempha ya magazi, makamaka chifukwa cha kukana insulini.
Mlingo wa mawonekedwe ndi mapangidwe a Pioglitazone
Gawo lofunikira la mankhwalawa ndi pioglitazone hydrochloride. Piritsi limodzi, kuchuluka kwake kumatengera mlingo - 15 kapena 30 mg. Yogwira pophika mu kapangidwe amathandizidwa ndi lactose monohydrate, hydroxypropyl cellulose, calcium carboxymethyl cellulose, magnesium stearate.
Mapiritsi oyera oyera amatha kuzindikiridwa ndi mawonekedwe a mawonekedwe a convex ndikulemba "15" kapena "30".
Mu mbale imodzi mapiritsi 10, m'bokosi - 3-10 mbale zotere. Alumali moyo wa mankhwala 2 zaka. Kwa pioglitazone, mtengo wake umangotengera mlingo wa mankhwalawo, komanso wopanga opanga: mapiritsi 30 a Indian Pioglar 30 mg aliyense angagulidwe ndi ma ruble 1083, mapiritsi 28 a Irish Actos 30 mg aliyense - kwa ma ruble 3000.
Makhalidwe a pharmacological
Pioglitazone ndimamwa mankhwala a hypoglycemic a gulu la thiazolidatedione. Zochita za mankhwala zimaphatikizidwa ndi kukhalapo kwa insulin: kutsitsa pansi kwa mphamvu ya chiwindi ndi minyewa yake kumadzi, kumakweza mtengo wa shuga ndipo kumachepetsa kapangidwe kake m'chiwindi. Poyerekeza ndi mankhwala a sulfonylurea, pioglitazone simalimbikitsa maselo a b omwe ali ndi vuto la kupanga insulin ndipo sathandizira kukalamba ndi necrosis.
Kuchepa kwa kukana kwa insulin mu mtundu wachiwiri wa shuga kumathandizira kusintha mawonekedwe a glycemic komanso mfundo za glycated hemoglobin. Ndi zovuta za metabolic, mankhwalawa amathandizira kuwonjezeka kwa milingo ya HDL komanso kutsika kwa milingo ya triglycerol. Zambiri za cholesterol yathunthu ndi LDL sizinasinthe.
Ikulowa m'matumbo, mankhwalawa amatengeka ndi chidwi, mpaka amafika mpaka m'magawo 2 ndi bioavailability 80%. Kuchulukana kophatikizana kwa kuchuluka kwa mankhwalawa m'magazi kunalembedwa chifukwa cha 2 mpaka 60 mg. Chotsatira chokhazikika chimapezeka mutatha kumwa mapiritsiwo m'masiku 4 mpaka 77 oyamba.
Kugwiritsanso ntchito mobwerezabwereza sikumapangitsa kuti mankhwalawa akhale ochuluka. Kuchuluka kwa mayamwa sikudalira nthawi yomwe mulandire michere.
Pioglitazone imachotsedwa ndowe (55%) ndi mkodzo (45%). Mankhwalawa, omwe amachotsedwa mu mawonekedwe osasinthika, amakhala ndi theka la moyo wa maola 5-6, chifukwa cha metabolites, maola 16-23.
Zaka za odwala matenda ashuga sizikhudza mankhwala a pharmacokinetics. Ndi kukanika kwa aimpso, zomwe zimakhala ndi glitazone ndi ma metabolites ake zimakhala zotsika, koma mawonekedwewo azikhala ofanana, kotero kugwiritsidwa ntchito kwa mankhwala aulere kumasungidwa.
Ndi kulephera kwa chiwindi, kuchuluka kwa mankhwalawo m'magazi kumakhala kosalekeza, ndikuwonjezereka kwa kuchuluka kwamagawidwe, chilolezo chichepetsedwa, ndipo gawo la mankhwala laulere lidzakulitsidwa.
Zizindikiro zogwiritsidwa ntchito
Pioglitazone imagwiritsidwa ntchito kuwongolera matenda amtundu wa 2 shuga onse monga monotherapy ndi chithandizo chovuta, ngati kusintha kwamachitidwe (zakudya zochepa zamafuta, masewera olimbitsa thupi, kuwongolera kwamunthu wam'maganizo) sikuthandizira glycemia.
Mankhwala osokoneza bongo, regimens wapawiri wokhala ndi metformin amagwiritsidwa ntchito (makamaka kunenepa kwambiri), ngati monotherapy yokhala ndi metformin pamankhwala othandizira samapereka 100% glycemic control. Pankhani yotsutsana ndi metformin, pioglitazone imaphatikizidwa ndi mankhwala a sulfonylurea, ngati kugwiritsa ntchito monotherapy sikumapereka zotsatira zomwe mukufuna.
Kuphatikizika kwa pioglitazone komanso kuphatikiza kwapatatu ndi metformin ndi sulfonylurea kukonzekera ndikotheka, makamaka kwa odwala onenepa kwambiri, ngati malingaliro am'mbuyomu sangapereke mbiri yabwino ya glycemic.
Mapiritsi ndi oyeneranso odwala matenda a shuga a 2 omwe amadalira insulin, ngati jakisoni wa insulin sangayang'anire shuga mokwanira, ndipo metformin imatsutsana kapena salekerera wodwalayo.
Contraindication
Kuphatikiza pa hypersensitivity pazosakaniza za formula, pioglitazone osavomerezeka:
- Odwala omwe ali ndi matenda amtundu 1;
- Ndi matenda ashuga ketoacidosis;
- Odwala omwe ali ndi vuto lalikulu la chiwindi;
- Ngati mu anamnesis - zam'mtima zojambulajambula. I - IV NYHA;
- Ndi macroscopic hematuria osatsimikizika etiology;
- Anthu odwala matenda ashuga ndi oncology (khansa ya chikhodzodzo).
Zochita Zamankhwala
Kugwiritsa ntchito pioglitazone ndi digoxin, warfarin, fenprocoumone ndi metformin sikumatha mphamvu zawo zamankhwala. Zisakhudze pharmacokinetics ndi kugwiritsa ntchito glitazone yokhala ndi zotumphukira za sulfonylurea.
Kafukufuku wokhudzana ndi momwe pioglitazone amathandizira kulera pakamwa, calcium blockers, cyclosporine, ndi HMCA-CoA reductase inhibitors sanawonetse kusintha kwawo.
Kugwiritsanso ntchito kwa pioglitazone ndi gemfibrozil kumadzetsa kuwonjezeka kwa AUC ya glitazone, yomwe imadziwika ndi kudalirika kwa nthawi yayitali, katatu. Zinthu zoterezi zimawonjezera mwayi wowoneka kuti ndiwosakhudzidwa ndi zotsatira zoyipa za mankhwalawa, motero, mlingo wa pioglitazone uyenera kusinthidwa mukaphatikizidwa ndi inhibitor.
Mlingo wa pioglitazone umachulukitsidwa pamene rifampicin imagwiritsidwa ntchito limodzi. Kuyang'anira glycemia ndikofunikira.
Malangizo ogwiritsa ntchito Pioglitazonum
Malangizo a pioglitazone ogwiritsira ntchito amalimbikitsa kuti odwala matenda ashuga azigwiritsa ntchito 1 p. / Tsiku. Piritsi imamezedwa ndi madzi, adokotala amasankha mlingo womwe umaganizira zamankhwala am'mbuyomu, zaka, gawo la matendawa, concomitant pathologies, kusintha kwa thupi.
Ndi chithandizo chovuta ndi insulin, mlingo wa chomaliza umasinthidwa malinga ndi kuwerenga kwa glucometer ndi mawonekedwe a zakudya.
Kwa odwala matenda ashuga okalamba, palibe chifukwa chosintha mankhwalawa, amayamba ndi otsika, amawonjezeka pang'onopang'ono, makamaka ndi malingaliro omwe amaphatikizidwa - izi zimapangitsa kuti zizolowereka zizigwirizana komanso zimachepetsa ntchito yamavuto.
Ndi kukanika kwa aimpso (kulengedwa kwa creatinine kupitirira 4 ml / min.), Glitazone imalembedwa mwachizolowezi, sichisonyezedwa kwa odwala a hemodialysis, komanso kulephera kwa chiwindi.
Malangizo owonjezera
Mphamvu ya regimen yosankhidwa imawunikidwa miyezi itatu iliyonse pogwiritsa ntchito glycated hemoglobin assows. Ngati palibe chochita, siyani kumwa mankhwalawo. Kugwiritsa ntchito pioglitazone nthawi yayitali kungakhale ndi chiopsezo, chifukwa chake, adotolo amayenera kuyang'anira chitetezo cha mankhwalawa.
Mankhwala amatha kusunga madzimadzi m'thupi ndikuwonjezera vuto mu mtima. Ngati wodwala matenda ashuga ali pachiwopsezo cha ukalamba, vuto la mtima kapena matenda a mtima, mlingo woyambira uyenera kukhala wochepa.
Kusintha kumathekera ndi zoyeserera zabwino. Gululi la odwala matenda ashuga ayenera kuwunika kawirikawiri thanzi lawo (kulemera, kutupa, zizindikiro za matenda amtima), makamaka ndi malo ochepera a diastolic.
Chidwi chachikulu popereka mankhwala ayenera kuperekedwa kwa odwala matenda ashuga okalamba (kuyambira azaka 75), popeza palibe chidziwitso pakugwiritsa ntchito mankhwalawa. Ndi kuphatikiza kwa pioglitazone ndi insulin, mtima pathologies atha kupitilizidwa. Pakadali pano, chiopsezo cha khansa, ma fractures chikuwonjezereka, chifukwa chake popereka mankhwala, ndikofunikira kuwunikira zabwino zenizeni komanso zomwe zingavulaze.
Kuyesedwa kwa zamankhwala kumatsimikizira mwayi wokhala ndi khansa ya chikhodzodzo mutatha kudya pioglitzone. Ngakhale chiwopsezo chotsika (0,06% poyerekeza 0,02% pagulu lolamulira), zinthu zonse zomwe zimatulutsa khansa (kusuta fodya, kupanga zovulaza, kutsitsa kwa pelvic, zaka) ziyenera kuwunika.
Mankhwala asanaikidwe, ma enzyme a chiwindi amayendera. Ndi kuwonjezeka kwa ALT ndi 2,5 nthawi komanso kukomoka kwa chiwindi, mankhwalawa amatsutsana. Ndi kukula kwamphamvu kwa ma cell a chiwindi, pioglitazone imatengedwa mosamala.
Ndi zizindikiro za hepatic kusokonezeka (kusokonezeka kwa dyspeptic, kupweteka kwa epigastric, anorexia, kutopa kosalekeza), michere ya chiwindi imayendera. Kupitilira muyeso 3 nthawi, komanso mawonekedwe a chiwindi, ziyenera kukhala chifukwa chosiya mankhwala.
Ndi kuchepa kwa kukana kwa insulini, kugawidwanso kwamafuta kumachitika: ma visceral amatsika, komanso owonjezera pamimba. Ngati kulemera kumalumikizidwa ndi edema, ndikofunikira kuwongolera kugwira ntchito kwa mtima ndi kudya kwa kalori.
Chifukwa cha kuchuluka kwa magazi, hemoglobin imatha kutsika ndi 4%. Kusintha kofananako kumawonedwa mukamamwa mankhwala ena a antidiabetic (a metformin - 3-4%, sulfonylurea kukonzekera - 1-2%).
Pakuphatikiza kawiri komanso katatu ndi pioglitazone, insulin ndi sulfonylurea, chiopsezo cha hypoglycemia chikuwonjezeka. Ndi zovuta zochizira, kusinthanitsa kwa mankhwalawa panthawi yake ndikofunikira.
Thiazolidinediones zimatha kuchititsa kuti maselo azikhala ndi tulo komanso kutupa. Mukalumikizana ndi ophthalmologist, ndikofunikira kuganizira za mtundu wa macular edema wokhala ndi pioglitazone. Pali chiopsezo cha mafupa owundana.
Chifukwa cha umboni wokwanira wosakwanira komanso chitetezo pokhudzana ndi pakati komanso mkaka wa m`mawere, azimayi sasankhidwa polyglitazone nthawi imeneyi. Mankhwala ndi contraindified mu ubwana.
Mukamayendetsa magalimoto kapena maginito ovuta, kufunikira kwa zotsatira zoyipa mutagwiritsa ntchito glitazone kuyenera kuganiziridwanso.
Mankhwala osokoneza bongo osokoneza bongo komanso osafunika
Ndi monotherapy ndi mapulani ovuta, zochitika zosafunikira zalembedwa:
- Macular edema, kuwonongeka kwa mawonekedwe;
- Anemia
- Hypersthesia, mutu;
- Zofooka za kupuma dongosolo, sinusitis ndi pharyngitis;
- Ziwengo, anaphylaxis, hypersensitivity, angioedema;
- Kuchepa kwa kugona;
- Tumors zamitundu yosiyanasiyana: ma polyps, cysts, khansa;
- Zopweteka ndi zowawa m'malire;
- Defecation mungoli chisokonezo;
- Kukanika kwa Erectile;
Hypoglycemia, chilakolako chosalamulirika;- Hypesthesia, kusokonezeka kwa mgwirizano;
- Vertigo;
- Kulemera kwakukula ndi kukula kwa ALT;
- Glucosuria, proteinuria.
Hypoglycemia, chilakolako chosalamulirika;Maphunzirowa adayesa chitetezo cha mlingo wa 120 mg, omwe odzipereka adatenga masiku 4, kenako masiku ena 7 mg ndi 180 mg. Palibe zizindikiro zowonjezera bongo zomwe zapezeka.
Zinthu za Hypoglycemic ndizotheka ndi regimen zovuta ndi insulin ndi kukonzekera kwa sulfonylurea. Chithandizo cha mankhwalawa ndichizindikiro komanso chothandizira.
Pioglitazone - analogues
Pamsika waku US wa mankhwala othandizira, omwe ali amodzi kwambiri padziko lapansi, pioglitazone amakhala ndi gawo lofanana ndi metformin. Pankhani ya mikangano kapena kulekerera bwino kwa pioglitazone, itha kulowedwa ndi Avandia kapena Roglit - analogues yozikidwa pa rosiglitazone - mankhwala a gulu lomwelo la thiazolidinediones, komabe, kulosera kwakutali kwa gululi ndikukhumudwitsa.
Kuchepetsa kukana insulin ndi biguanides. Pankhaniyi, pyoglizatone ikhoza kusinthidwa ndi Glucophage, Siofor, Bagomet, NovoFormin ndi mankhwala ena a metformin.
Kuchokera pagawo la mankhwala osokoneza bongo a hypoglycemic, analogues aku Russia ndi otchuka: Diab-standard, Diaglitazone, Astrozone. Chifukwa cha mndandanda wokhazikika wa contraindication, kuchuluka kwake komwe kumachulukana ndi zovuta mankhwala, munthu ayenera kusamala ndi kusankha kwa analogues.
Kufufuza kwa Makasitomala
About pioglitazone, ndemanga za anthu odwala matenda ashuga amasakanikirana. Omwe adamwa mankhwala oyambirirawo amawona kugwira ntchito bwino komanso zotsatira zoyipa zochepa.
Mapeto ake ndi osagwirizana: mankhwalawa amachepetsa kwambiri glycemia, glycated hemoglobin komanso kufunika kwa insulin (makamaka ndi zovuta mankhwala). Koma sioyenera aliyense, chifukwa chake simuyenera kuyesa azaumoyo, kupeza mankhwalawa popatsidwa upangiri ndi abwenzi. Katswiri yekha ndi amene amatha kusankha kuthekera kwa chithandizo chotere komanso algorithm yolandirira pioglitazone.
Mutha kuphunzira zambiri zakugwiritsa ntchito thiazolidinediones pamankhwala azachipatala kuchokera pa kanema:
